Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

“My Baby's Right Eye Is Red”

Helen H. Yeung, MD

Abstract

A 2-month-old male infant (Figure 1) was referred for further evaluation because his mother reported that his right eye had been red since birth. He was born via cesarean section at 39 weeks. His mother reported that the right eye was noticeably red compared to the normal-appearing left eye immediately after birth. Soon after discharge, epiphora was noticed from the right eye associated with mucopurulent discharge. At 2 weeks of age, the opinion was expressed that the conjunctival redness of the right eye would improve on its own. The redness persisted and suspected conjunctivitis was treated with erythromycin ointment at 1 month of age. The epiphora and discharge did not improve with the medication and the infant was referred for further ophthalmologic examination. On examination, the infant appeared well with no systemic abnormalities. Bilateral upper eyelid discoloration and some injection in the occipital area and left parietal region was noted. Handheld slit-lamp examination revealed a slight haze of the right cornea associated with a larger corneal diameter. For the right eye only, inspection of the conjunctiva showed dense vascularization circumferentially that was most intense temporally. In contrast, the conjunctiva and sclera of the left eye were strikingly white. The lacrimal strip seemed only moderately increased on the right side compared to the left. The lenses were clear. Intraocular pressure by applanation tonometry was 30 and 18 mm Hg in the right and left eyes, respectively. Axial lengths were measured to be 19 and 16 mm in the right and left eyes, respectively, and B-scan ultrasonography suggested a thicker choroid on the right than the left. Cycloplegic refraction found 2.00 diopters of myopia in the right eye and no refractive error in the left eye. Funduscopy showed cupping with a cup–disc ratio of 0.6 in the right eye and a well-vascularized disc with a cup–disc ratio of 0.1 in the left eye. Medication failed to control the intraocular pressure and glaucoma surgery was recommended for the right eye. A goniotomy was performed at 3 months of age that failed to improve control of the eye pressure. Gonioscopy on the right side showed no visible scleral spur and ciliary body band, whereas the scleral spur and ciliary body band could be easily defined on the left side. At 10 months of age, a trabeculectomy with mitomycin C was recommended.

What's Your Diagnosis?

The correct answer for What's Your Diagnosis? is unilateral glaucoma with excessive conjunctival and episcleral vessels with choroidal thickening.…

A 2-month-old male infant (Figure 1) was referred for further evaluation because his mother reported that his right eye had been red since birth. He was born via cesarean section at 39 weeks. His mother reported that the right eye was noticeably red compared to the normal-appearing left eye immediately after birth. Soon after discharge, epiphora was noticed from the right eye associated with mucopurulent discharge. At 2 weeks of age, the opinion was expressed that the conjunctival redness of the right eye would improve on its own. The redness persisted and suspected conjunctivitis was treated with erythromycin ointment at 1 month of age. The epiphora and discharge did not improve with the medication and the infant was referred for further ophthalmologic examination. On examination, the infant appeared well with no systemic abnormalities. Bilateral upper eyelid discoloration and some injection in the occipital area and left parietal region was noted. Handheld slit-lamp examination revealed a slight haze of the right cornea associated with a larger corneal diameter. For the right eye only, inspection of the conjunctiva showed dense vascularization circumferentially that was most intense temporally. In contrast, the conjunctiva and sclera of the left eye were strikingly white. The lacrimal strip seemed only moderately increased on the right side compared to the left. The lenses were clear. Intraocular pressure by applanation tonometry was 30 and 18 mm Hg in the right and left eyes, respectively. Axial lengths were measured to be 19 and 16 mm in the right and left eyes, respectively, and B-scan ultrasonography suggested a thicker choroid on the right than the left. Cycloplegic refraction found 2.00 diopters of myopia in the right eye and no refractive error in the left eye. Funduscopy showed cupping with a cup–disc ratio of 0.6 in the right eye and a well-vascularized disc with a cup–disc ratio of 0.1 in the left eye. Medication failed to control the intraocular pressure and glaucoma surgery was recommended for the right eye. A goniotomy was performed at 3 months of age that failed to improve control of the eye pressure. Gonioscopy on the right side showed no visible scleral spur and ciliary body band, whereas the scleral spur and ciliary body band could be easily defined on the left side. At 10 months of age, a trabeculectomy with mitomycin C was recommended.

What's Your Diagnosis?

The correct answer for What's Your Diagnosis? is unilateral glaucoma with excessive conjunctival and episcleral vessels with choroidal thickening.

References

  1. Saeedi OJ, Chang LY, Arora KS, Jampel HD, Quigley HA. Unilateral glaucoma associated with conjunctival angioma and choroidal thickening without facial angioma. Middle East Afr J Ophthalmol. 2016;23:280–282.
  2. Yeung HH, Walton DS. Clinical classification of childhood glaucomas. Arch Ophthalmol. 2010;128:680–684. doi:10.1001/archophthalmol.2010.96 [CrossRef]
  3. Yeung HH. “My baby's eye is large…and always pink.”J Pediatr Ophthalmol Strabismus. 2017;54:10–11. doi:10.3928/01913913-20161219-02 [CrossRef]
Authors

From the Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

The author has no financial or proprietary interest in the materials presented herein.

Correspondence: Helen H. Yeung, MD, 2 Longfellow Place, Suite 201, Boston, MA 02114. E-mail: helen.h.yeung.md@gmail.com

10.3928/01913913-20171214-01

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